Equal stroke volumes, different costs: left ventricular 4D flow in normal and failing hearts
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KeywordsStroke Volume Heart Failure Patient Cardiac Remodel Normal Left Ventricular Left Ventricular Stroke Volume
Although total left ventricular (LV) stroke volume (SV) is equal in healthy subjects and heart failure patients with mild LV remodeling, the SV’s transventricular flow paths to ejection and diastolic energetics are different. These flow-specific markers of inefficiency of the failing heart are detectable prior to clinical decompensation, and might be predictors of progressive adverse cardiac remodeling.
Heart failure is a common disorder with a dismal prognosis. Cardiac remodeling is a key component of heart failure that progresses from adaptive to maladaptive as the disease worsens, and is associated with increased risks of symptoms and mortality. In earlier stages of heart failure with adaptive remodeling, patients may remain clinically compensated and the failing heart’s left ventricular (LV) stroke volume (SV) remains the same as in the normal heart. Recently, time-varying and complex three-dimensional flow patterns and energetics within the normal LV have been demonstrated. Based on such 4D flow-specific measures, we hypothesized that while the SV of normal and failing LVs may be equal, the SV’s diastolic kinetic energy (KE) and transventricular routes to ejection are different in the two states.
Although total LV stroke volume is equal in healthy subjects and in clinically compensated heart failure patients with mild LV remodeling, the diastolic routes through the LV and pre-systolic energetics of the SV are significantly different in the two states. Inefficient flow may augment the chronic stress on the failing heart’s reserve, promoting progressive maladaptive cardiac remodeling.
The Swedish Research Council
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